Posterior Capsular Opacification

Return of Blurry Vision After Cataract Surgery

I had both my Cataract Surgeries in October last year, a short five months ago. My vision was so amazing after surgery I felt like I was on cloud nine!

Cataract Surgery, A Patient’s Journal

Cataract Surgery, A Patient's Journal

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But over the last 4-6 weeks, I started noticing I was needing my drugstore readers more and more often because I couldn’t focus on the smaller print again, or the light was too dim. Now I have the Symfony lenses, so super fine print and low light required the readers on occasion, but this was beginning to be an increasing necessity. I was scheduled for a dilated followup, so I waited until that visit to discuss with my surgeon.

I work here at The Harman Eye Clinic, so I knew what was happening… I had Posterior Capsular Opacity (PCO) and was going to need a YAG Laser* treatment. I’ve been here long enough to know that 20-30% of cataract patients develop significant PCO and require this treatment to clear up their vision. I also know it can be anywhere from 2 weeks to 20+ years before it’s needed! Some people refer to it as an “after cataract” because it’s something that develops after cataract surgery. It’s also referred to as a “secondary cataract” which also means after cataract. It isn’t the cataract coming back. It’s not something that went wrong with your surgery. It’s just that some people can develop a thickening of the back (posterior) of the lens capsule which holds the artificial lens in place. This thickening of the capsule causes your vision to become cloudy (opaque).

Sure enough, my exam showed that glare was back and my vision was decreased. Time to schedule the YAG appointments.

While the procedure name sounds pretty unusual, the procedure itself is fairly simple. There weren’t any restrictions… in fact it’s a lot like going for an eye exam! Vitals, drops to dilate the eye that was going to be treated, sit down in front of the laser with your chin in a chin rest, focus on a little green light for a few minutes and you’re done. The surgeon uses the laser to create a small opening in the capsule to allow what you see to get to your retina without having to pass through that opaque tissue. My surgeon explained that I might notice some floaters afterwards (which I didn’t) and to call if I had problems.

I used some artificial tears after I got home because my eye felt dry, and I was dilated for a couple of hours. I drove myself, went shopping on my way home and resumed normal activities… except I couldn’t read through that blurry eye!

*YAG is the abbreviation for Yttrium Aluminum Garnet which is a crystal that is used as a lasing medium (see, YAG is much easier!).

Learn more from a video about Yag LasersI

A Happy Patient Is An Informed Patient

watch-informed-consent-001You might ask, “What are possible temporary side effects after cataract surgery?”   To answer this question and to help you prepare when you talk with your surgeon, here are frequent questions and concerns patients ask about after surgery.

BLURRED VISION:  what are common causes of blurred vision after cataract surgery?

  • Dropless cataract surgery is routinely performed at The Harman Eye Clinic, and causes black dots in the vision for at least day or two after surgery.  Patients are instructed to sit upright for at least a few hours when the get home to help the medicine settle to the bottom of the eye, like a snow globe.
  • Dilation lasts for at least a day or two after cataract surgery and commonly causes blurred vision.
  • PCO or posterior capsular opacification occurs 10-20% after routine cataract surgery.  It causes glare at night, but is curable by a simple YAG laser procedure that takes 2 minutes to perform, but an hour and a half for the paperwork!
  • CME or cystoid macular edema occurs about 1% of the time after routine cataract surgery.  It causes difficulty reading and even distance vision.  Risk factors include diabetes, ERM (epiretinal membrane), prior retinal surgery and possibly cigarette smoking.  It often can be cured with topical steroid and anti-inflammatory eye drops.
  • Residual refractive error may cause blur until new spectacles are prescribed.  If a monofocal lens is chosen for best distance vision, then near vision will be blurred (so called presbyopia) until readers are used.
  • Dry Eye syndrome is a life long condition, that may cause fluctuating vision, and may be worse at least temporarily after cataract surgery.  It is often exacerbated by prescription eye drops (especially generic drops such as ketorolac), but we are seeing much less dry eye problems since switching to dropless surgery.
  • ARMD (age related macular degeneration) or ERM may also limit vision due to aging changes in the retina.

DYSPHOTOPSIAS are unwanted visual phenomena occurring after routine cataract surgery.

  • Negative dysphotopsia are likened to “horse blinders” with a shadow or dark crescent on the side and usually subside within days or weeks. They are thought to be more common in square edged lens implants, but have been reported in all types of lens implants, however they are not dangerous.
  • Positive dysphotopsia are less common, and are often described as an arc of light under certain lighting conditions.

REBOUND IRITIS IS INFLAMMATION that occurs usually 2 to 3 weeks after cataract surgery.

  • It is thought to be a result of the dropless medicine wearing off, especially found in darkly pigmented patients.  It happens in less than 10% of patients who have dropless surgery and is treated with topical steroids.  This is the best reason for patients to keep their 3-week postoperative appointment after surgery.

For more information.  download a free copy of our Cataract Surgery Patient Workbook, here.

Or take time to read, A Patient’s Journal – Cataract Surgery